Y (A Child : Fact Finding : Fabricated Induced Illness)

In fact-finding proceedings concerning suspected fabricated or induced illness, the local authority must prove each disputed fact on the balance of probabilities. Findings must rest on the totality of the evidence and proper inferences, not speculation or suspicion. Medical opinion is important but does not determine the issue: the court must assess it alongside witness credibility and the possibility of an unknown cause. A parent’s motivation is not an additional requirement where the evidence establishes knowing interference with a child’s feeding plan contrary to medical advice. Expert evidence must demonstrate searching, independent scrutiny of the relevant records and engage fairly with the parties’ cases.

The local authority brought care proceedings concerning two young boys, X and Y. It alleged that Y’s mother had exaggerated or fabricated symptoms, interfered with feeding and medical equipment, contaminated lines, and physically harmed Y during feeds. Y had substantial pre-existing gastrointestinal difficulties and underwent prolonged treatment in several hospitals.

The central questions were whether the alleged conduct was proved, whether it caused or was likely to cause significant harm, and whether Y’s recovery after the mother was excluded from his care supported the alleged causation.

1. Outcome. The court made the majority of the local authority’s requested findings. It found that the mother had exaggerated or fabricated reports of vomiting and pain, interfered with feeding plans and equipment, disconnected a feeding line, damaged a Hickman line, and caused Y pain during feeds. This behaviour caused or was likely to cause significant physical and emotional harm.
2. Proof and evaluation. The burden remained on the local authority. Each allegation had to be proved separately on the balance of probabilities. The court considered the whole evidential picture, including medical records, witness credibility, expert evidence, circumstantial evidence and the possibility of an unknown medical cause.
3. Expert evidence. The court rejected Dr Yadav’s evidence because it did not provide the searching and independent scrutiny required, failed fairly to address the mother’s explanations, adopted a disputed conclusion about physical assault, and inaccurately summarised important records. The court approved the principle stated in Westminster CC v M, F and H [2017] EWHC 518 (Fam).
4. Limits of findings. The court declined to find that the mother had caused the line infections because the microbiological evidence lacked a safe evidential foundation. It also declined additional allegations where the evidence was insufficient or findings would be disproportionate.
5. Threshold. Applying section 31(2) of the Children Act 1989, the court found significant harm attributable to care which was not what it would be reasonable to expect a parent to give. The mother’s motivation was immaterial once knowing interference with the feeding plan contrary to medical advice was proved.

First-instance fact-finding decision in care proceedings. The proceedings had been case managed by HHJ Lazarus before transfer to the High Court for the fact-finding hearing.